Intended for healthcare professionals

Clinical Review

Recent developments in plastic surgery

BMJ 2002; 325 doi: (Published 10 August 2002) Cite this as: BMJ 2002;325:319
  1. D Johnson, specialist registrar (,
  2. I H Whitworth, consultant
  1. Department of Plastic and Reconstructive Surgery, Salisbury District Hospital, Salisbury SP2 8JB
  1. Correspondence to: D Johnson
  • Accepted 31 May 2002

Misconceptions still abound that plastic surgeons are predominantly cosmetic surgeons. Plastic surgery is a technique based specialty with the aim of reconstructing tissue so that patients gain normal function and appearance. As a result plastic surgery encompasses a vast range (see box and Our review focuses on advances in surgical techniques, technical and biological advances (see also, and changes in the organisation of plastic surgery, with its intergration with other specialties.

Conditions treated by plastic surgeons

  • Congenital abnormalities

  • Breast surgery

  • Trauma

  • Oculoplastic conditions

  • Hand surgery

  • Malignancy

  • Reanimation for facial palsy

  • Burns

  • Aesthetic surgery

  • Laser surgery

  • Chronic wound management

  • Vascular malformations


We selected topics for review by searching Medline from 1 January 1998 and by reviewing abstracts from the past four annual meetings of the British and American Associations of Plastic Surgeons, the Congress of the International Confederation of Plastic, Reconstructive and Aesthetic Surgery, and the International Society of Craniofacial Surgeons.

Surgical advances

Microvascular free tissue transfer

The development of microsurgical techniques has made it possible to replant severed body parts, ranging from whole limbs to fingertips, by anastomosing the divided blood vessels along with nerves and other injured structures. Success depends on the mechanism of injury (clean cuts do better than crush injuries), the correct management of the amputated part (keeping it cool but not frozen), prompt surgery (ideally within a few hours of injury), and the skill of the microsurgeon.

Recent developments

Microvascular free tissue transfer is part of routine plastic surgical practice

Surgical advances in microvascular free tissue transfer have focused on reducing morbidity at the donor site

A range of technological and biological advances promise to lead to improvements in the management of nerve injury, skin cancers, and wounds

Pioneering surgery involving neuroelectric stimulation of limb muscles in tetraplegic patients can restore hand function

The integration of plastic surgery into hospital practice has paralleled a multidisciplinary approach to …

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